Medication Adherence in Oncology: The Role of Oral Anti-Cancer Drugs and Copayments

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Use of oral anti-cancer drugs has increased within the last five years and, with 25% of the cancer drugs in development administered orally (Giuseppe, 2010), it will continue to increase. Ten oncologists, five each from the United States and Australia, were interviewed to understand their views on the implications of the switch from IV to oral anti-cancer drugs, the role adherence and copayment play in their treatment decisions, and their use of adherence interventions. Relevant literature was analyzed and compared to the findings from the primary research. Most American and Australian physicians agreed that their use of orals had increased and would likely increase in the next five years. However, treatment decisions were driven by disease and standards of care, not by route of administration. These oncologists did not view adherence as a primary concern for patients on oral anti-cancer drugs. They reported high levels of perceived adherence, estimating that 55% to 100% of their patients were adherent to oral anti-cancer therapy, with no differences between the countries. The primary difference between American and Australian oncologists was the role of copayment on treatment decision. All Americans said patient copay was a significant factor in their treatment decision, whereas all Australians said it was not. In both countries, the oncologists had minimal experience with adherence interventions (other than basic patient education) and mixed receptivity to their usefulness. The overstated perceived adherence rates found in this study are documented in the literature, but they are not supported by actual adherence studies. Oncologists need to be educated on documented adherence rates for oral anti-cancer drugs so that they devote adequate time to educating patients on the importance of compliance and persistency. Additionally, the United States must consider the broad policy implications of its reimbursement system that makes copayment a primary factor in treatment choice.

Presentation: 28 minutes

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